不同全麻方法复合硝普钠控制性降压对机体细胞免疫功能的影响
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摘要
目的
观察三种不同全麻方法复合硝普钠控制性降压时，口腔颌面部整形患者血液动力学和血浆白介素-6(Interleukins-6，IL-6)、白介素-10(Interleukins-10，IL-10)水平的变化，比较不同全麻方法复合硝普钠控制性降压对机体细胞免疫功能的影响。
方法
选择择期口腔颌面部整形患者30例，ASAⅠ～Ⅱ级，随机分为三组：芬太尼复合异氟烷吸入麻醉组(Ⅰ组)、芬太尼和丙泊酚复合异氟烷吸入麻醉组(Ⅱ组)、瑞芬太尼复合丙泊酚全凭静脉麻醉组(Ⅲ组)，每组各10例患者。三组均用硝普钠行控制性降压，将平均动脉压(mean arterial pressure，MAP)降低30％左右，维持40分钟以上。分别记录麻醉前(T_0)、麻醉后降压前(基础值，T_1)、降压后10分(T_2)、20分(T_3)、40分(T_4)、停止降压后2分(T_5)、5分(T_6)、10分(T_7)、15分(T_8)、20分(T_9)的收缩压(systolic blood pressure，SBP)、舒张压(diastolic blood pressure，DBP)、MAP、心率(heart rate，HR)、率压积(rate pressure product，RPP，即SBP×HR)、脉搏血氧饱和度(pulse oxygen saturation，SpO_2)、呼气末二氧化碳分压(end-tidal carbondioxide partial pressure，PETCO_2)。于T_1、T_4及T_7三个时间点，分别抽取病人动脉血标本5ml，采用放射免疫法检测IL-6和IL-10的水平。
结果
1、MAP：在停止降压后的T_5、T_7时，Ⅲ组明显低于Ⅰ组(P<0．05)；T_6时，Ⅲ组明显低于Ⅰ组、Ⅱ组(P<0．05)；与T_1相比，Ⅰ组患者的MAP在T_5、T_6、T_7、T_8时，均显著升高(P<0．05)；Ⅱ组患者的MAP从T_6时开始升高，在T_7、T_8时均高于基础水平(P<0．05)。
2、HR：控制性降压开始后T_2、T_3、T_4时，与T_1相比，三组的HR均升高(P均<0．05)；但Ⅲ组明显低于Ⅰ组、Ⅱ组(P<0．05)。
3、RPP：在控制性降压开始后T_2、T_3、T_4时，直至停止降压后T_5、T_6、T_7时，与T1相比，Ⅰ组、Ⅱ组患者的RPP均明显高于基础水平(P<0．05)。在控制性降压过程中，即T_2、T_3、T_4时，Ⅲ组患者的RPP明显低于Ⅰ组、Ⅱ组(P<0．05)；在停止降压后T_5、T_6、T_7时，Ⅲ组患者的RPP仍明显低于Ⅰ组(P<0．05)。
4、IL-6和IL-10：与T_1相比，在T_4、T_7时三组患者的IL-6均显著升高(P<0．05)；在T_7时，Ⅲ组患者IL-6的水平明显低于Ⅰ组、Ⅱ组(P<0．05)。与T_1相比，在T_4、T_7时三组患者的IL-10均显著升高(P<0．05)；在T_7时，Ⅰ组患者IL-6的水平明显低于Ⅱ组、Ⅲ组(P<0．05)。
结论
不同全麻方法和麻醉药物对手术期间的血流动力学反应和细胞免疫功能有不同的影响。瑞芬太尼复合丙泊酚全凭静脉麻醉能够减轻手术刺激和硝普钠引起的有害的血流动力学反应，提供稳定的血流动力学状态。并且，瑞芬太尼复合丙泊酚全凭静脉麻醉较之芬太尼复合异氟烷吸入麻醉和芬太尼-丙泊酚复合异氟烷吸入麻醉，使血浆IL-6水平降低IL-10水平升高，从而有利于围手术期机体的细胞免疫功能。
Objective
To observe the change of haemodynamics and plasma interleukins-6, interleukins-10 made by three different methods of general anesthesia combined with controlled hypotension induced by sodium nitroprusside(SNP) in oral and maxillofacial plastic surgery patients. To compare the effects of different general anesthesia combined with controlled hypotension induced by sodium nitroprusside on cellular immune function.
Methods
Thirty patients, ASAⅠ～Ⅱ, scheduled for oral and maxillofacial plastic surgery, were randomly divided into three groups: fentanyl-isoflurane group (groupⅠ, n=10); fentanyl-propofol-isoflurane group (groupⅡ, n=10); remifentanil-propofol group (groupⅢ, n=10). All of them were controlled hypotension induced by sodium nitroprusside. Mean arterial pressure (MAP) will be reduced about 30%, maintain more than 40 minutes. Before anesthesia(T_0); after anesthesia before hypotension (basic value, T_1); 10 minutes(T_2), 20 minutes(T_3), 40 minutes(T_4) after hypotension; 2 minutes(T_5), 5 minutes(T_6), 10 minutes(T_7), 15 minutes(T_8), 20 minutes(T_9) after stopped hypotension, record the date of systolic blood pressure (SBP), diastolic blood pressure (DBP), MAP and heart rate(HR), rate pressure product(RPP, SBP×HR), pulse oxygen saturation(SpO_2), end-tidal carbon dioxide partial pressure(P_(ET)CO_2). The 5ml samples of artery blood were collected at T_1, T_4, T_7. The levels of interleukins-6 and interleukins-10 in the plasma were measured by radioimmunoassay (RIA).
Results
1. MAP: In groupⅢ, MAP was significantly lower than that of groupⅠat T_5, T_7 (P<0.05). In groupⅢ, MAP was significantly lower than that of groupⅠand groupⅡat T_6(P<0.05). In groupⅠ, MAP was significantly increased than that of groupⅡat the T_5, T_6, T_7, T_8 (P<0.05). In groupⅡ, MAP began to increase at T_6, and still higher than base level at T_7, T_8 (P<0.05).
2. HR: At T_2, T_3, T_4, HR was higher in all three groups compared with that at T_1 (P<0.05). But in the groupⅢ, HR was significantly lower than that of groupⅠand groupⅡ(P<0.05).
3. RPP: In groupⅠand groupⅡ, RPP was significantly higher than the basis level at T_2, T_3, T_4, T_5, T_6, T_7 (P<0.05). In groupⅢ, RPP was significantly lower than that of groupⅠand groupⅡat T_2, T_3, T_4 (P<0.05). In groupⅢ, RPP was still significantly lower than that of groupⅠat T_5, T_6, T_7(P<0.05).
4. Interleukins-6 and interleukins-10: At T_4 and T_7, interleukins-6 and interleukins-10 were significantly increased compared with them at T_1 (P<0.05). In groupⅢ, interleukins-6 was significantly lower than that of groupⅠandⅡat T_7 (P<0.05). In groupⅠ, interleukins-10 was significantly lower than that of groupⅡandⅢat T_7 (P<0.05).
Conclusion
Different anesthetic methods and anesthetic drugs had different effects on hemodynamic response and cellular immune function during surgical operation. TIVA with propofol-remifentanil appears to mitigate potentially hazardous hemodynamic responses from operative stimuli and side effects of controlled hypotension induced by sodium nitroprusside(SNP). Interleukins-6 levels were increased and interleukins-10 levels were decreased in patients anesthetized with propofol-remifentanil compared to anesthetized with isoflurane-fentanyl or propofol-isoflurane-fentanyl. Therefore, it is conducive to perioperative cellular immune function.
观察三种不同全麻方法复合硝普钠控制性降压时，口腔颌面部整形患者血液动力学和血浆白介素-6(Interleukins-6，IL-6)、白介素-10(Interleukins-10，IL-10)水平的变化，比较不同全麻方法复合硝普钠控制性降压对机体细胞免疫功能的影响。
方法
选择择期口腔颌面部整形患者30例，ASAⅠ～Ⅱ级，随机分为三组：芬太尼复合异氟烷吸入麻醉组(Ⅰ组)、芬太尼和丙泊酚复合异氟烷吸入麻醉组(Ⅱ组)、瑞芬太尼复合丙泊酚全凭静脉麻醉组(Ⅲ组)，每组各10例患者。三组均用硝普钠行控制性降压，将平均动脉压(mean arterial pressure，MAP)降低30％左右，维持40分钟以上。分别记录麻醉前(T_0)、麻醉后降压前(基础值，T_1)、降压后10分(T_2)、20分(T_3)、40分(T_4)、停止降压后2分(T_5)、5分(T_6)、10分(T_7)、15分(T_8)、20分(T_9)的收缩压(systolic blood pressure，SBP)、舒张压(diastolic blood pressure，DBP)、MAP、心率(heart rate，HR)、率压积(rate pressure product，RPP，即SBP×HR)、脉搏血氧饱和度(pulse oxygen saturation，SpO_2)、呼气末二氧化碳分压(end-tidal carbondioxide partial pressure，PETCO_2)。于T_1、T_4及T_7三个时间点，分别抽取病人动脉血标本5ml，采用放射免疫法检测IL-6和IL-10的水平。
结果
1、MAP：在停止降压后的T_5、T_7时，Ⅲ组明显低于Ⅰ组(P<0．05)；T_6时，Ⅲ组明显低于Ⅰ组、Ⅱ组(P<0．05)；与T_1相比，Ⅰ组患者的MAP在T_5、T_6、T_7、T_8时，均显著升高(P<0．05)；Ⅱ组患者的MAP从T_6时开始升高，在T_7、T_8时均高于基础水平(P<0．05)。
2、HR：控制性降压开始后T_2、T_3、T_4时，与T_1相比，三组的HR均升高(P均<0．05)；但Ⅲ组明显低于Ⅰ组、Ⅱ组(P<0．05)。
3、RPP：在控制性降压开始后T_2、T_3、T_4时，直至停止降压后T_5、T_6、T_7时，与T1相比，Ⅰ组、Ⅱ组患者的RPP均明显高于基础水平(P<0．05)。在控制性降压过程中，即T_2、T_3、T_4时，Ⅲ组患者的RPP明显低于Ⅰ组、Ⅱ组(P<0．05)；在停止降压后T_5、T_6、T_7时，Ⅲ组患者的RPP仍明显低于Ⅰ组(P<0．05)。
4、IL-6和IL-10：与T_1相比，在T_4、T_7时三组患者的IL-6均显著升高(P<0．05)；在T_7时，Ⅲ组患者IL-6的水平明显低于Ⅰ组、Ⅱ组(P<0．05)。与T_1相比，在T_4、T_7时三组患者的IL-10均显著升高(P<0．05)；在T_7时，Ⅰ组患者IL-6的水平明显低于Ⅱ组、Ⅲ组(P<0．05)。
结论
不同全麻方法和麻醉药物对手术期间的血流动力学反应和细胞免疫功能有不同的影响。瑞芬太尼复合丙泊酚全凭静脉麻醉能够减轻手术刺激和硝普钠引起的有害的血流动力学反应，提供稳定的血流动力学状态。并且，瑞芬太尼复合丙泊酚全凭静脉麻醉较之芬太尼复合异氟烷吸入麻醉和芬太尼-丙泊酚复合异氟烷吸入麻醉，使血浆IL-6水平降低IL-10水平升高，从而有利于围手术期机体的细胞免疫功能。
Objective
To observe the change of haemodynamics and plasma interleukins-6, interleukins-10 made by three different methods of general anesthesia combined with controlled hypotension induced by sodium nitroprusside(SNP) in oral and maxillofacial plastic surgery patients. To compare the effects of different general anesthesia combined with controlled hypotension induced by sodium nitroprusside on cellular immune function.
Methods
Thirty patients, ASAⅠ～Ⅱ, scheduled for oral and maxillofacial plastic surgery, were randomly divided into three groups: fentanyl-isoflurane group (groupⅠ, n=10); fentanyl-propofol-isoflurane group (groupⅡ, n=10); remifentanil-propofol group (groupⅢ, n=10). All of them were controlled hypotension induced by sodium nitroprusside. Mean arterial pressure (MAP) will be reduced about 30%, maintain more than 40 minutes. Before anesthesia(T_0); after anesthesia before hypotension (basic value, T_1); 10 minutes(T_2), 20 minutes(T_3), 40 minutes(T_4) after hypotension; 2 minutes(T_5), 5 minutes(T_6), 10 minutes(T_7), 15 minutes(T_8), 20 minutes(T_9) after stopped hypotension, record the date of systolic blood pressure (SBP), diastolic blood pressure (DBP), MAP and heart rate(HR), rate pressure product(RPP, SBP×HR), pulse oxygen saturation(SpO_2), end-tidal carbon dioxide partial pressure(P_(ET)CO_2). The 5ml samples of artery blood were collected at T_1, T_4, T_7. The levels of interleukins-6 and interleukins-10 in the plasma were measured by radioimmunoassay (RIA).
Results
1. MAP: In groupⅢ, MAP was significantly lower than that of groupⅠat T_5, T_7 (P<0.05). In groupⅢ, MAP was significantly lower than that of groupⅠand groupⅡat T_6(P<0.05). In groupⅠ, MAP was significantly increased than that of groupⅡat the T_5, T_6, T_7, T_8 (P<0.05). In groupⅡ, MAP began to increase at T_6, and still higher than base level at T_7, T_8 (P<0.05).
2. HR: At T_2, T_3, T_4, HR was higher in all three groups compared with that at T_1 (P<0.05). But in the groupⅢ, HR was significantly lower than that of groupⅠand groupⅡ(P<0.05).
3. RPP: In groupⅠand groupⅡ, RPP was significantly higher than the basis level at T_2, T_3, T_4, T_5, T_6, T_7 (P<0.05). In groupⅢ, RPP was significantly lower than that of groupⅠand groupⅡat T_2, T_3, T_4 (P<0.05). In groupⅢ, RPP was still significantly lower than that of groupⅠat T_5, T_6, T_7(P<0.05).
4. Interleukins-6 and interleukins-10: At T_4 and T_7, interleukins-6 and interleukins-10 were significantly increased compared with them at T_1 (P<0.05). In groupⅢ, interleukins-6 was significantly lower than that of groupⅠandⅡat T_7 (P<0.05). In groupⅠ, interleukins-10 was significantly lower than that of groupⅡandⅢat T_7 (P<0.05).
Conclusion
Different anesthetic methods and anesthetic drugs had different effects on hemodynamic response and cellular immune function during surgical operation. TIVA with propofol-remifentanil appears to mitigate potentially hazardous hemodynamic responses from operative stimuli and side effects of controlled hypotension induced by sodium nitroprusside(SNP). Interleukins-6 levels were increased and interleukins-10 levels were decreased in patients anesthetized with propofol-remifentanil compared to anesthetized with isoflurane-fentanyl or propofol-isoflurane-fentanyl. Therefore, it is conducive to perioperative cellular immune function.
引文
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22 kazmaier S , Hanekop GG , Buhre W , et al. Myocardial consequences of remifentanil in patients with coronary artery disease. Br Anaesth. 2000; 84(5): 578-583.
23江学成，张育才，胡宁利等．瑞芬太尼和异丙酚联合闭环靶控输注麻醉的可行性．中华麻 醉学杂志．2004；24(8)：632-633.
24 Blood BC , Finander LS , Flack WE , et al. Effect of clonidine on sympathoadrenal response during sodium nitroprusside hypotension. Anesth Analg. 1996; 65: 469.
25 Koinig H , Wallner T , Marhofer P , et al. Magnesium sulfate reduces intra- and postoperative analgesic requirements. Anesth Analg. 1998; 87:206-10.
26 Sanders GM , Sim KM. Is it feasible to use magnesium sulphate as a hypotensive agent in oral and maxillofacial surgery? Ann A cad Med Singapore. 1998; 27: 780-5.
27 Elsharnouby NM , Elsharnouby MM. Magnesium sulphate as a technique of hypotensive anaesthesia. Br J Anaesth. 2006; 96(6): 727-31.
28 Andel D , Andel H , Horauf K , et al. The influence of deliberate hypotension on splanchnic perfusion balanc nitroglycerin. Anesth Analg. 2001; 93(5): 1116-1120.
29 Sharrock NE , MineoR , Urquhart B , et al. The effect of two levels hypotension on intraoperative blood loss during total hip arthroplasy performed under lumbar epidural anesthesia. Anesth Analg. 1993; 76: 580-4.
30 Endoh H , Honda T , Ohashi S , et al. The influence of nitroglycerin and prostaglandin E_1 on dynamic cerebral autoregulation in adult patients during propofol and fentanyl anaesthesia. Anaesthesia. 2001; 56: 947-952.
31 Lv R , Zhou W, Duan M , et al. Ultrastructural changes, nuclear factor-kappaB activation, and tumor necrosis factor-alpha expression in brain after acute normovolemic hemodilution and controlled hypotension in rats. Croat Med J. 2008; 49(1): 22-31
32 Tomiyasu S , Hara T , Hasuo H , et al. Comparative analysis of systemic and coronary hemodynamics during sevoflurane- and isoflurane-induced hypotension in dogs. J Cardiovasc Phannacol. 1999; 33(5): 741-747.
33 Sharrock NE , Bading B , Mineo R , et al. Deliberate hypotensive epidural anesthesia for pantents with normal and low cardiac output. Anesth Analg. 1994; 79(5): 899-904.
34 Hara T , Fukusaki M , Nakamura T , et al. Renal function in patients during and after by potensive anesthesia with sevoflurane. J Clin Anesth. 1998; 10(7): 539-45.
35 Takeda S , Tomaru,T , Inada Y. Splanchnic organ blood flow during calcitonin gene-related peptide-controlled hypotension with or without propranolol in dogs. Anesth Analg. 2000; 90: 1275-1280.
36 Fukusaki M , Maekawa T , Yamaguchi K , et al. Combined effects of prolonged prostaglandin E_1-controlled hypotension and haemodilution on human hepatic function. Eur J Anaesthesiol. 1997; 14(2): 157-63.
37 Fulusaki M , Miyako M , Hara T , et al. Effects of controlled hypotension with sevoflurane anaesthesia on hepatic function of surgic patients. Eur J Anaesthesiol. 1999; 16(2): 111-6.
38 Ottmar Kick , Hugo Van Aken , Patrick F , et al. Vital organ blood flow during deliberate hypotension in dogs. Anesth Analg. 1993; 77: 737-42.
39 Preckel MP , Ferber Viart C , Leftheriotis G , et al. Autoregulation of human inner ear blood flow during middle ear surgery with propofol or isoflurane anesthesia during controlled hypotension. Anesth Analg. 1998; 87(5): 1002-8.
40 Degoute CS , Ray MJ , Manchon M , et al.Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anaesth. 2001; 48(1): 20-7.
41 Bernard JM , Pinaud M , Francois T , et al. Deliberate hypotension with nicardipine or nitroprusside during total hip arthroplasty. Anesth Analg. 1991; 73: 341-5.
42 Takakura K , SugiuraY , Goto Y. Differential microcirculation dynamics during deliberate hypotension induced by nicardipine, PGE_1 and trimethaphan in rat mesentery. Can J Anaesth. 1995; 42: 1035-9.
43 Aoki H , Inoue M , Mizobe T , et al. Platelet function is inhibited by nitric oxide liberation during nitroglycerin-induced hypotension anaesthesia. Br J Anaesth. 1997; 79: 476-81.
44 Piper N , Suttner SW , Schindt CC , et al. Acutc phase response to nitroprusside-controlled hypotension in patients undergoing radical prostatectomy. Anesthesia. 2000; 55(2): 131-6.
45 Liuzzo N. The prognostic value of C-reactive protein and serum amyloid A protein in severe unstable angina. New Eng J of Med. 1995; 331: 417-24.
46 Lake CL. Induced hypotension. In: Lake CL, Moore RA, et al. Blood: Hemostasis, Transfusion, and Alternatives in the perioperative period. New York: Raven Press, 1995. 395.
2 Vallejo R , Hord ED , Barna SA, et al. Perioperative immunosuppression in cancer patients. J Environ Partial Toxicol Oncol. 2003; 22(2): 139-46.R.
3 Qing M , Vazquez-Jimenez JF , Klosterhalfen B , et al. Influence of temperature during cardiopulmonary bypass on leukocyte activation, cytokine balance, and post-operative organ damage. Shock. 2001; 15: 372-377.
4 Gilliland HE , Armstrong MA , Carabine U , et al. The choice of anesthetic maintenance technique influences the anti-inflammatory cytokine response to abdominal surgery. Anesth Analg. 1997; 85:1394-1398.
5 Qing M , Vazquez-Jimenez JF , Klosterhalfen B , et al. Influence of temperature during cardiopulmonary bypass on leukocyte activation, cytokine balance, and post-operative organ damage. Shock. 2001; 15: 372-377.
6 Miller LC , Lynch EA , Isa S , et al. Balance of synovial fluid IL-1beta and IL-1 receptor antagonist and recovery from Lyme arthritis. Lancet. 1993; 341: 146-8.
7 McBride WT, Armstrong MA, Crockard AD, et al. Cytokine balance and immunosuppressive changes at cardiac surgery: contrasting response between patients and isolated CFB circuits. Br JAnaesth. 1995; 75(6): 724-33.
8 Alli SS , Dubukaitis A , Qattan AR. The ralationship between end tidal carbon dioxide and arterial carbon dioxide during controlled hypotensive anaesthesia. Med Princ Pract. 2002; 11(1): 35-37.
9 Heesen M , Menges T , Dietrich GV , et al. Increase in interleukin-6 plasma concentrations following hypotensive anesthesia with sodium nitroprusside. Anaesthesist. 1995; 44(5): 328-33.
10 Inada T , Yamanouchi Y , Jomura S , et al. Effect of propofol and isoflurane anesthesia on the immune response to surgery. Anaesthesia. 2004; 59: 954 - 959.
11 Torri G , Casati A. Cardiovascular homeostasis during inhalational general anesthesia: a clinical comparison between sevoflurane and isoflurane. On behalf of the Italian Research Group on sevoflurane. J ClinAnesth. 2000; 12(2): 117-122.
12 Sudheer PS , Logan SW , Ateleanu B , et al. Haemodynamic effects of the prone position: a comparison of propofol total intravenous and inhalation anaesthesia. Anaesthesia. 2006; 61(2): 138-41.
13 Monk TG , Saini V , Weldon BC , et al. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg. 2005; 100(1): 4-10.
14 Eberhart LH , Folz BJ , Wulf H , et al. Intravenous anesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery. Laryngoscope. 2003; 113(8): 1369-1373.
15 Schuttler J , Albrecht S , Breivik H , et al. A comparison of remifentanil and alfentanil in patients undergoing major abdominal surgery. Anaesthesia. 1997; 52:307-17.
16 Mertens MJ , Olofsen E , Engbers FH , et al. Propofol reduces perioperative remifentanil requirements in a synergistic manner: response surface modeling of perioperative remifentanil-propofol interactions. Anesthesiology. 2003; 99(2): 347-359.
17 Kato M , Honda I , Suzuki H , et al. Interleukin-10 production during and after upper abdominal surgery. J ClinAnesth. 1998; 10: 184-188.
18 Holzheimer RG , Steinmetz W. Local and systemic concentrations of pro- and anti-inflammatory cytokines in human wounds. Eur J Med Res. 2000; 5: 347-55.
19 Terregino CA , Lopez BL , Karras DJ , et al. Endogenous mediators in emergency department patients with presumed sepsis: Are levels associated with progression to severe sepsis and death? Ann Emerg Med. 2000; 35: 26-34.
20 Coopersmith CM , Amiot DM, Stromberg PE , et al. Antibiotics improve survival and alter the inflammatory profile in a murine model of sepsis from Pseudomonas aeruginosa pneumonia. Shock. 2003; 19: 408-414.
21 Helmy SA , Wahby MA , El-Nawaway M. The effect of anaesthesia and surgery on plasma cytokine production. Anaesthesia. 1999; 54(8): 733-738.
22 Mahdy AM , Galley HF , Abdel-Wahed MA , et al. Differential modulation of interleukin-6 and interleukin-10 by diclofenac in patients undergoing major surgery. Br J Anaesth. 2002; 88(6): 797-802.
23 Grewe M, Gyufko K, Krutmann J. Interleukin-10 production by cultured human keratinocytes: regulation by ultraviolet B and ultraviolet Al radiation. J Invest Dermatol. 1995; 104: 3-6.
24 Graziola E , Elena G , Gobbo M , et al. Stress, hemodynamic and immunological responses to inhaled and intravenous anesthetic techniques for video-assisted laparoscopic cholecystectomy. Rev Esp Anestesiol Reanim. 2005; 52(4): 208-16.
1 AR Aitkenhead, G Smith · Textbook of Anaesthesia · Third edition· 1999 · 596-599.
2 O'Connor PJ , Hanson J , Finucane BT. Induced hypotension with epidural/general anesthesia reduces transfusion in radical prostate surgery. Can J Anaesth. 2006; 53(9): 873-80.
3 李树人,韩如泉,槐庆元等.七氟醚对犬血流动力学影响的实验研究.中华麻醉学杂志. 1996; 16(11): 543.
4 Nakamura K , Toda H , Hatanoy , et al. Comparison .of the direct effects of sevoflurane, isoflurane and halothane on isolated canine coronary orteneries. can J Anesth. 1993; 40(3): 257.
5 Mikhail MS , Thangathurai D , Thaker KB , et al. Echocardiographic assessment of coronary blood flow velociry during controlled hypotensive anesthesia with nitroglycerin. J Cardiothorac Vasc Anesth. 2000; 14(5): 565-70.
6 Degoute CS , Ray MJ , Manchon M , et al. Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anesth. 2001; 48(1): 20-27.
7 Alli SS , Dubukaitis A , Qattan AR. The ralationship between end tidal carbon dioxide and arterial carbon dioxide during controlled hypotensive anaesthesia. Med Princ Pract. 2002; 11(1): 35-37.
8 Sutmer SW , Lang K , Boldt J , et al. The influence hyperoxic ventilation during sodium nitroprusside-induced hypotension on skeletal muscle tissue oxygen tension. Anesthesiology. 2002; 96(5): 1103-1108.
9 Massoud TF , Hademenos GT , Young WL , et al. Can induction of systemic hypotension help prenvent nidus rupure complication of arteriovenous malforamation embolizationm? AJNR Am J Neuroradiol. 2000; 21 (7): 1255-67.
10 Pakulski C , Nowicki R , Kowalczyk P , et al. The influence of controlled hypotension on splanchnic mucosal perfusion using gastric tonometry in patients undergoing resection of meninggioma. Med Sci Monit. 2002; 8(1): CR28-30.
11 Hersey SL , O Dellne , Lowe S , et al. Nicardipine versus nitroprusside for controlled hypotension during spinal surgery in adolescent. Anesth Analg. 1997; 84: 1239.
12 Takeda S , Ozawa Y , Tomaru T , et al. Haemiodynamic effects of hypotension induced by KRN2391 and nicardipine in isoflurane anaesthetized dogs. Can J Anaesth. 1997; 44: 1002-7.
13 Schoffstall JM , Spivey WH , Gambone LM , et al. Effects of calcium channel blocker overdose-induced toxicity in the conscious dog. Ann Emerg Med. 1991; 20:1144-8.
14 Tobias JD , Berkenbosch JW. Initial experience with dexemedetomidine in paediatric-aged patients. Paediatr Anaesth. 2002; 12(2): 171-175.
15 Noma T , Ichinoche T , Kaneko Y. Inhibition of physiologic stress responses by regional nerve block during orthognathicsurgy under ATP induced hypotensive anaesthesia. Oral Surgy Oral med. 1998; 86(5): 511-5.
16 Sato J, Saito S , Takahashi T, et al. Sevoflurane and nitrous oxide anaesthesia suppresses heart rate variability during deliberate hypotension. Eur J Anaesthesiol. 2001; 18(12): 805-810.
17 Endoh H , Honda T , Ohashi S , et al. The influence of nicardipin-, nitroglycerin-, and prostaglandin E_1-induced hypotension on cerebral pressure autoreguration in adult patients during propofol-fentanyl aneasthesia. Anesth Analg. 2002; 94(1): 169-73.
18张诗海，曾帮雄，金士翱等．降钙素基因相关肤控制性降压对大鼠血流动力学和器官血流 的影响．中华麻醉学杂志．1997；17(2)：94-96．
19 Guy J , Hindman BJ , Baker KZ , et al. Comparison of remifentanil and fentanyl in patients undergoing craniotomy for supratentorial space-occupying lesions. Anesthesiology. 1997; 86: 514-24.
20 Schüttler J , Albrecht S , Breivik H , et al. A comparison of remifentanil and alfentanil in patients undergoing major abdominal surgery. Anaesthesia. 1997; 52: 307-17.
21 Degoute CS , Ray MJ , Gueugniaud PY , et al. Remifentanil induces consistent and sustained controlled hypotension in children during middle ear surgery. Can J Anaesth. 2003; 50(3): 270-276.
22 kazmaier S , Hanekop GG , Buhre W , et al. Myocardial consequences of remifentanil in patients with coronary artery disease. Br Anaesth. 2000; 84(5): 578-583.
23江学成，张育才，胡宁利等．瑞芬太尼和异丙酚联合闭环靶控输注麻醉的可行性．中华麻 醉学杂志．2004；24(8)：632-633.
24 Blood BC , Finander LS , Flack WE , et al. Effect of clonidine on sympathoadrenal response during sodium nitroprusside hypotension. Anesth Analg. 1996; 65: 469.
25 Koinig H , Wallner T , Marhofer P , et al. Magnesium sulfate reduces intra- and postoperative analgesic requirements. Anesth Analg. 1998; 87:206-10.
26 Sanders GM , Sim KM. Is it feasible to use magnesium sulphate as a hypotensive agent in oral and maxillofacial surgery? Ann A cad Med Singapore. 1998; 27: 780-5.
27 Elsharnouby NM , Elsharnouby MM. Magnesium sulphate as a technique of hypotensive anaesthesia. Br J Anaesth. 2006; 96(6): 727-31.
28 Andel D , Andel H , Horauf K , et al. The influence of deliberate hypotension on splanchnic perfusion balanc nitroglycerin. Anesth Analg. 2001; 93(5): 1116-1120.
29 Sharrock NE , MineoR , Urquhart B , et al. The effect of two levels hypotension on intraoperative blood loss during total hip arthroplasy performed under lumbar epidural anesthesia. Anesth Analg. 1993; 76: 580-4.
30 Endoh H , Honda T , Ohashi S , et al. The influence of nitroglycerin and prostaglandin E_1 on dynamic cerebral autoregulation in adult patients during propofol and fentanyl anaesthesia. Anaesthesia. 2001; 56: 947-952.
31 Lv R , Zhou W, Duan M , et al. Ultrastructural changes, nuclear factor-kappaB activation, and tumor necrosis factor-alpha expression in brain after acute normovolemic hemodilution and controlled hypotension in rats. Croat Med J. 2008; 49(1): 22-31
32 Tomiyasu S , Hara T , Hasuo H , et al. Comparative analysis of systemic and coronary hemodynamics during sevoflurane- and isoflurane-induced hypotension in dogs. J Cardiovasc Phannacol. 1999; 33(5): 741-747.
33 Sharrock NE , Bading B , Mineo R , et al. Deliberate hypotensive epidural anesthesia for pantents with normal and low cardiac output. Anesth Analg. 1994; 79(5): 899-904.
34 Hara T , Fukusaki M , Nakamura T , et al. Renal function in patients during and after by potensive anesthesia with sevoflurane. J Clin Anesth. 1998; 10(7): 539-45.
35 Takeda S , Tomaru,T , Inada Y. Splanchnic organ blood flow during calcitonin gene-related peptide-controlled hypotension with or without propranolol in dogs. Anesth Analg. 2000; 90: 1275-1280.
36 Fukusaki M , Maekawa T , Yamaguchi K , et al. Combined effects of prolonged prostaglandin E_1-controlled hypotension and haemodilution on human hepatic function. Eur J Anaesthesiol. 1997; 14(2): 157-63.
37 Fulusaki M , Miyako M , Hara T , et al. Effects of controlled hypotension with sevoflurane anaesthesia on hepatic function of surgic patients. Eur J Anaesthesiol. 1999; 16(2): 111-6.
38 Ottmar Kick , Hugo Van Aken , Patrick F , et al. Vital organ blood flow during deliberate hypotension in dogs. Anesth Analg. 1993; 77: 737-42.
39 Preckel MP , Ferber Viart C , Leftheriotis G , et al. Autoregulation of human inner ear blood flow during middle ear surgery with propofol or isoflurane anesthesia during controlled hypotension. Anesth Analg. 1998; 87(5): 1002-8.
40 Degoute CS , Ray MJ , Manchon M , et al.Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anaesth. 2001; 48(1): 20-7.
41 Bernard JM , Pinaud M , Francois T , et al. Deliberate hypotension with nicardipine or nitroprusside during total hip arthroplasty. Anesth Analg. 1991; 73: 341-5.
42 Takakura K , SugiuraY , Goto Y. Differential microcirculation dynamics during deliberate hypotension induced by nicardipine, PGE_1 and trimethaphan in rat mesentery. Can J Anaesth. 1995; 42: 1035-9.
43 Aoki H , Inoue M , Mizobe T , et al. Platelet function is inhibited by nitric oxide liberation during nitroglycerin-induced hypotension anaesthesia. Br J Anaesth. 1997; 79: 476-81.
44 Piper N , Suttner SW , Schindt CC , et al. Acutc phase response to nitroprusside-controlled hypotension in patients undergoing radical prostatectomy. Anesthesia. 2000; 55(2): 131-6.
45 Liuzzo N. The prognostic value of C-reactive protein and serum amyloid A protein in severe unstable angina. New Eng J of Med. 1995; 331: 417-24.
46 Lake CL. Induced hypotension. In: Lake CL, Moore RA, et al. Blood: Hemostasis, Transfusion, and Alternatives in the perioperative period. New York: Raven Press, 1995. 395.